Organizational behavior issues
in health organizations
Organizational behavior, whether in a healthcare or other type of organization, is concerned with
behavior that occurs under the conditions posed by an organizational situation. While a specific
organization setting may create unique challenges or certain sets of problems, the behaviors of
interest are similar to those of individuals, groups, and often organizations in other settings or
industries (Weick, 1969). Thus, healthcare organization behavior does not create unique
management issues so much as certain issues are more prevalent in health care and occur along
with other challenges (Shortell & Kaluzny, 2000). Many of these challenges directly or indirectly
affect what is expected of healthcare workers and how they behave in healthcare organizations.
Health organizations are staffed with a highly professional workforce and impose exacting
requirements on how work is organized and accomplished. The complex work has a high risk of
serious or deadly error, which necessitates highly reliable systems of practice at all organization
levels. Complex technical and medical systems demand sophisticated technical expertise, which
requires a highly educated, efficient, and well-coordinated workforce. Professional workers,
especially physicians, work with a great deal of autonomy and control over the technical and
clinical aspects of care delivery. As a result, healthcare managers are responsible for facilitating
the delivery of highly complex medical services that must be carefully coordinated by
autonomous professionals over whom the manager has little direct authority all within an
industry system that is facing extreme financial and policy challenges.
Squeezed by rising costs and declining reimbursements, many health organizations struggle to
survive financially. In the face of increased competition and consumer demands, the health
delivery system is changing rapidly to create new services and adopt new technologies, often by
forming new partnerships. The chronic health conditions that characterize an aging population
demand more outpatient care, which dramatically changes the nature of care delivery. Concerns
over patient safety and quality of care demands workers skilled in clinical information
management, total quality management, and evidence-based practice, yet labor shortages abound
and are predicted to increase. The work of health care is carried out against the backdrop of these
demands. Yet every day, the healthcare manager facilitates and orchestrates the accomplishment
of organizational goals with an eye towards helping employees and colleagues successfully
negotiate the complexities presented by the nature of healthcare work and the healthcare
industry. To do this, the managers must be sure they themselves and those with whom they work
continually find ways to effectively work together in a demanding industry. Organizational
behavior skills help managers do this.
Organizational science explanations of human behavior increasingly draw upon human thinking,
especially cognition and the creation of meaning. In the cognitive framework, behavior is
inextricably tied to thinking. We cannot understand behavior without understanding the thoughts,
assumptions, and attributes of a situation that precede behavior and its consequences. Cognition
refers to the mental processes involved in thinking, including attending to information,
processing information, and ordering information to create meaning that is the basis for acting,
learning, and other human activities. Cognitive science has taught us that information processing
capacities and mental processes shape and govern one’s perceptions, language, and, ultimately,
one’s behaviors. A focus on thinking highlights the importance of perceptions, assumptions, and
social cues. It points out biases in information processing and creating common meaning during
communication. Finally, it sets the stage for learning in that the human capacity to adapt is
rooted in new ways of thinking and acting. Studies of thinking teach managers that humans have
a limited capacity to process information, causing them to simplify and take shortcuts; that
individuals’ actions are largely determined by how they perceive the world; and that humans
engage in an ongoing construction of their world by using stored information structures to guide
their perception and interpretation of events and information (Fiske & Taylor, 1984). In short,
the lessons of cognition suggest that the foremost management task is to create common
understanding among organization members.
While thinking has long been implicit in understanding organization behavior, its importance
grows in a knowledge economy that is driven by information (Huff, Huff & Barr, 2000). The
effective healthcare manager works with organization members and constituents to make sense
of their interactions and experiences and agree upon meaning so they can work together, make
decisions, and take action. The rest of this chapter describes some cognitive principles
commonly present in human interaction that often complicate organizational processes, and then
discusses ways a manager can work to create a shared understanding that facilitates
organizational effectiveness.
